Provider Demographics
NPI:1285608307
Name:JOHNSON, CAROLYN LEE (WHNP, APN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:WHNP, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4324
Mailing Address - Country:US
Mailing Address - Phone:815-531-7403
Mailing Address - Fax:
Practice Address - Street 1:22285 PEPPER RD.
Practice Address - Street 2:SUITE 111
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010
Practice Address - Country:US
Practice Address - Phone:847-382-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health